Cryptic Early Gastric Carcinoma in Gastric Stump: Challenges in Diagnostic Evaluation

• Main Authors: Subramanya Sakaleshpura Mallikarjunappa (Author), Shriram Jakate (Author)
• Format: Book
• Published: Hindawi Limited, 2019-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2090-6781; 2090-679X; 10.1155/2019/1794370
• Keywords: Pathology; RB1-214
• Source: Case Reports in Pathology, Vol 2019 (2019)

Partial gastrectomy, performed for any indication, is a well-recognized risk factor for carcinoma developing in the gastric remnant (so-called "gastric stump carcinoma"). In symptomatic patients with gastro-enteric anastomosis, it is a common practice to endoscopically evaluate the patency and the status of the anastomosis and procure biopsy samples when endoscopic abnormalities are noted. We describe a case with Billroth I gastroduodenal anastomosis with oozing and friability at the anastomosis site which was biopsied. The biopsies showed invasive intestinal-type adenocarcinoma. Subsequent completion gastrectomy showed no grossly visible tumor and required extensive initial and additional sampling of the anastomosis and the surrounding stomach to locate a small focus of invasive adenocarcinoma limited to the mucosa ("early gastric carcinoma"). This case illustrates a known complication of partial gastrectomy and highlights challenges in diagnostic evaluation of early gastric carcinoma after gastrectomy.